Many countries chronically underinvest in critical public health functions like disease surveillance, diagnostic laboratories and emergency operations centres, which enable the early identification and containment of outbreaks.

So far, 37 countries have completed the rigorous peer-reviewed assessments, called the Joint External Evaluation (JEE), of their preparedness capacities to identify their gaps and needs. But that leaves 162 countries that have not. Moreover, only two of the countries that have completed this assessment have used the results to devise costed plans.

The report lays out 12 recommendations to ensure the adequate financing of the capabilities and infrastructure required to prevent, identify, contain and respond to infectious disease outbreaks.

The report urges national governments to prioritise financing preparedness in their domestic budgets, as should international donors.

Not investing enough in pandemic preparedness puts lives at risk and is bad economics. A severe pandemic could result in millions of deaths and cost trillions of dollars, and even smaller outbreaks can cost thousands of lives and cause immense economic damage.

The most conservative estimates suggest that pandemics destroy 0.1 to 1.0% of global GDP, on par with other global threats such as climate change. Recent economic work suggests that the annual global cost of moderately severe to severe pandemics is roughly $570 billion, or 0.7% of global income.

“Preparedness at a national level is the first line of defence against pandemic threats, and thus the foundation of universal health security. Yet we have underinvested in the capabilities and infrastructure essential for preparedness,” said former CEO of Standard Chartered Bank, who is Chair of the IWG and now a Senior Fellow at Harvard University, Peter Sands.

“Given the scale of risk to human lives and livelihoods, the investment case for financing preparedness is compelling. We must make it happen,” continued Sands.

Pandemic preparedness prevents, detects and responds to the spread of disease both in humans and in livestock that have close contact with humans. The last 30 years have seen a steady increase in the frequency and diversity of disease outbreaks. Just in the last few weeks, for example, Ebola has resurfaced in the Democratic Republic of the Congo (DRC) for the eighth time, with four possible deaths and 43 possible cases identified as of 23rd May. Importantly, DRC has had a strong track record of containing previous outbreaks.

“Pandemics can strike anywhere, and everyone is at risk – especially the poor and the vulnerable,” said World Bank Group President, Jim Yong Kim.

“We must finally break the cycle of panic and neglect in our response to grave threats from infectious diseases. We have to ensure we are prepared, so the next outbreak does not become the next pandemic,” continued Kim.

Failing to invest in preparedness is especially short-sighted given the low cost of preparedness relative to the devastating impact of a pandemic. In low- and middle-income countries that have calculated the cost of financing preparedness, the investment required is about $1 per person per year.

The IWG, established in November 2016, puts forward 12 far-reaching recommendations, including getting all national governments to commit to conducting assessment of preparedness and animal health capacities by the end of 2019; ensuring the results of these assessments are translated into costed action plans, supported by financing proposals and investment cases; reinforcing tax resources, including earmarked taxes, to finance preparedness; ensuring donors fulfil their commitments, focusing development assistance on large one-off capital expenses that countries cannot afford, on regional initiatives and on fragile states; and ensuring the economic risks of infectious diseases are factored into macroeconomic assessments and investment decision-making, like other systemic risks are.

“Outbreak preparedness is chronically under-funded, and we have been waiting for bold thinking on financing since at least the mid-nineties,” said Director-General of the WHO, Margaret Chan.

“Implementing the IWG recommendations will ensure that every country mobilises the resources necessary to prevent, detect, and respond to future outbreaks,” continued Chan.

The ultimate goal of robust pandemic preparedness is universal health security, which means protecting all people from threats to their health. Universal health security is an essential component of universal health coverage -where everyone can obtain the quality health services they need, while not being pushed into poverty by having to pay out-of-pocket for health care costs. Universal health security contributes to and depends on stronger and more resilient health systems, and is critical to achievement of the sustainable development goals.